Use of Noninvasive Ventilation To Wean Critically Ill Adults from Invasive Ventilation: A Meta-Analysis.

Noninvasive ventilation as a weaning strategy for mechanical ventilation in adults with respiratory failure: a Cochrane systematic review

“…Compared with our previous systematic review, 16 our updated review contains 4 new trials (2 of which are large), nearly doubles the number of included patients (994 v. 530), especially those with COPD, has narrower confidence intervals around point estimates of effect and shows that noninvasive weaning reduces weaning failure and reintubation rates overall, as well as mortality in the subgroup of patients with COPD. A recent systematic review included 16 trials evaluating bilevel noninvasive ventilation and continuous positive airway pressure to wean patients on invasive ventilation, prevent respiratory failure in postoperative patients ready for extubation, or treat postextubation respiratory failure.…”

“…Of the 961 unique records we found, we assessed 15 new articles for eligibility (Figure 1). 16 Although we identified 6 additional trials from our updated search, 1 author confirmed that his trial had been aborted and never published, and 1 trial had not been consistently randomized (see Appendix 2 for a list of the excluded studies, available at www .cmaj .ca /lookup /suppl /doi :10 .1503 /cmaj .130974 /-/DC1). Consequently, we included 4 newly identified trials in our analysis, [25][26][27][28] in addition to the 12 trials included in our previous review.…”

“…Consequently, we included 4 newly identified trials in our analysis, [25][26][27][28] in addition to the 12 trials included in our previous review. 16 Of the 16 included trials, 2 were published only in abstract form, 29,30 4 were published in Chinese, [31][32][33][34] 1 was a dissertation subsequently published in full, 35 and one was a pilot RCT. 28 We excluded 20 studies (11 identified through our updated search [ Figure 1] and 9 excluded previously; Appendix 2), including 9 newly identified publications, 1 abstract and the aborted trial ( Figure 1 25,38,39 in about 30% of patients in 2 trials 29,40 and in more than 20% of patients in 1 trial; 27 COPD was an exclusion criterion in 1 trial.…”

“…This review represents an update of a previously conducted systematic review and meta-analysis. 16 Research CMAJ, February 18, 2014, 186(3) E115 Note: COPD = chronic obstructive pulmonary disease, FiO2 = fraction of inspired oxygen, NIV = noninvasive ventilation, PaO2 = partial pressure of oxygen, PAV = proportional assist ventilation, PEEP = positive end-expiratory pressure, PIC = pulmonary infection control, SBT = spontaneous breathing trial, SIMV = synchronized intermittent mandatory ventilation, ST = spontaneous/timed, VPAP = variable positive airway pressure. *Trials evaluating patients with COPD and pulmonary infection, which enrolled patients who achieved PIC window criteria or after infection control was achieved.…”

“…13 However, with noninvasive weaning, clinicians must anticipate drying of secretions, accept that only partial ventilatory support can be provided and forfeit a protected airway. Since its initial description as a weaning modality, 14 RCTs and meta-analyses 15,16 have compared noninvasive ventilation with alternative weaning strategies. A recent guideline suggested that noninvasive ventilation could be used to facilitate early liberation from mechanical ventilation in patients who have COPD at centres with expertise in its use.…”